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Lecture 2

NURSE-UN 1255 Lecture Notes - Lecture 2: Fetal Alcohol Spectrum Disorder, 18 Months, 6 Years


Department
Nursing - Undergraduate
Course Code
NURSE-UN 1255
Professor
Nahum
Lecture
2

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Week 2 Peds: Well Child
1
TODDLER PRESCHOOL:
Sophia is now 2 years old. She arrives at the Pediatric Clinic for her 2 year old exam.
Toddlers: 1-3yo
Preschoolers: 3-6yo
Leading cause of death (1-4yo) is unintentional injury
Motor Vehicle injuries is the leading cause of injury death
1992 (20 per 100,000)
2004 (10 per 100,000)
Health supervision visits for Toddlers and Preschoolers
o 15 months
o 18 months
o 24 months
o 2 ½ years
o 3 years
o 3 ½ years
o 4 years
o 5 years
o 6 years
The nurse obtains Sophia’s height, weight, head circumference, BMI and vital signs
o HR: 90
o RR: 24
o Temperature: 98.9 F (axillary)
o BP: 80/60
o (**see pg 46-47 for vital sign norms for age)
o Height: 35 ½ in
o Weight: 28 ½ lb
o HC: 49 cm
o BMI: 15.9
Sophia’s parents ask the nurse if her vitals and growth is normal:
o Heart Rate: 70-110
o Respirations: 20-30
o Temperature: 99 F
o Blood Pressure: 90 105 / 55 70
o Growth: 3 inches/year
4 - 6 lbs./year
Sophia’s Growth Chart
Developmental Screenings
o 17% of children have a developmental delay
o Less than half are identified prior to starting school
o Early intervention (OT, PT, ST) can stimulate developmental milestones
o Cause of Developmental Delays
Genetic syndromes
Prematurity
Perinatal infections/toxin exposures (fetal alcohol syndrome)/hypoxia
Hypoxia during delivery
Vision impairments
Hearing impairments
Lead exposure

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Week 2 Peds: Well Child
2
CDC Baby Steps: Learn the Signs, Act Early
o http://www.cdc.gov/ncbddd/actearly/multimedia/video.html
Developmental Screening Tools
o Ages & Stages $15
o Bayley Infant Screener $25
o Infant development inventory $15
o Denver Developmental Screening $58
o Parents’ Evaluation of Development $15
o CDC Developmental Milestones FREE
o *Learn the Signs. Act Early
o Screening and Services
Gross Motor Skills: movements that use the large muscles in the arms, legs, torso and feet
Examples: standing, walking, running, jumping PT
Fine Motor Skills: movements that use the small muscles of the fingers, toes, wrists, lips and
tongue
Examples: grabbing using thumb and index finger, hand to mouth, eating OT
Oral/Motor Skills: language and communication, eating ST
Social/Emotional: eye contact, smiles, interaction SE
Cognitive: learning, thinking, problem solving SE
EIP provides PT, OT, ST and SE teacher
o Developmental Milestones
18 months: walks up and down stairs holding on, runs, builds tower of 2-3 cubes, says 15 or
more words, scribbles, self feeds (fingers), follows one step commands, points to 6 body parts
24 months: walks up and downstairs without help, can kick a ball forward, builds tower 6 cubes,
feeds doll, says about 50 words or more, uses 2 word phrases, uses pronouns “I”, “me”, brush
teeth with help, helps dress , uses spoon, speech is 50% intelligible
CT: A 2 year old patient walks on his tiptoes, has repetitive speech and little eye contact.
3 years old: pedals tricycle, broad jump, 3 to 4 word sentences, knows 2 actions, speech 75%
understandable, build tower of 10 cubes, thumb wiggle, imitates horizontal line, wash and dry
hands, put on T shirt
4 years old: hops, speech all understandable with complete sentences, follows three step
commands, copy cross, draw person 2-4 parts, brush teeth no help, dress no help, can count 4
objects
CT: What are we looking for in developmental screenings? What if the child is developmentally
delayed? What does that mean?
Nutritional Assessment
o Sophia’s parents report that she doesn’t like to eat but drinks plenty of milk. She does not like to sit down
in her high chair for feedings and therefore only eats a few bites of food and then takes her milk in a sippy
cup as she is roaming around the house. Her typical meals include:
Breakfast: 4 bites of pancakes with syrup and 1 cup of milk
AM snack: 1 box of raisins, a slice of cheese and a cup of milk
Lunch: ½ of a peanut butter sandwich and a cup of milk
PM snack: a cup of milk
Dinner: 4 bites of macaroni and cheese and a cup of milk
CT: Concerns with this diet?

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Week 2 Peds: Well Child
3
o Nutritional Needs
Toddlers need fewer calories per day than infants
Preschoolers need 90 cal/kg: average 1800 cal/day
Three meals and 2-3 snacks per day
Avoid juices, sodas
No more than 2 cups of milk per day
Food jags (eats only a few foods)
No force feeding
Mealtime should be a pleasant experience
Physical Assessment
o Allow warm-up time prior to touching child
o Remove only clothing needed for each part of assessment
o Proceed from LEAST intrusive to MOST intrusive
o Give choices when possible
o Primary dentition (20 teeth) completed by 30 months
o Anticipatory Guidance
Sleep
Oral Health
Mental Health
Play
Toilet Training
Lead Levels
Disease Prevention
Injury Prevention
Sleep Patterns
8-13 hours of sleep each day
Naps: 16mo-20mo morning nap eliminated; one long afternoon nap (1-3hours)
Nightmares (occur during early sleep) and
Night Terrors (occur during the second half of sleep)
Due to active imagination and increased dream state
Increased nightmares can be related to stress or anxiety
Oral Health
Dental caries in primary teeth has increased to 28% for children 2-5 years of age (2004).
Preventive care:
Brush teeth twice daily (soft brush, pea sized fluoride toothpaste)
Limit sweet drinks and snacks
Visit the dentist every 6 months
Mental Health
Temper Tantrums
Common in toddlers
Screaming, crying, kicking episodes
Toddlers way of expressing anger
Should decrease with age
Tantrum tips
Help avoid tantrum with distraction at early signs
Separate child from others (avoids attention getting)
Keep child safe
Remain calm (be a role model)
Do not give in (if you stop crying I’ll give you candy)
Reward improvement of behavior control (it was good that you were
able to calm down on your own)
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